05/18/2001

What Confidences Don't You Keep?

Q: If a 13-year-old reports to you during a counseling session that she is pregnant, do you keep the information confidential (and work with her on the issue of telling her parents) or are you mandated to report this as behavior that involves danger to oneself?

A: In general, parents have a strong interest in protecting the health and welfare of their child. The courts have recognized this parental interest as almost absolute for "minor minors" (children under the age of 14); have recognized normal 18-year-olds as being adults in charge of their own health and welfare, and view those between 14 and 18 as being in a state of developing autonomy who may make some of their own health care decisions. Laws vary from state to state in how they handle adolescent rights to decide their own health care.

In this situation, involving a child so young (age 13), information about the pregnancy should not be held in confidence. Having said that, I believe that the counselor must proceed judiciously in sharing the information. If there is reason to believe that the girl's parents would harm her if told, the counselor needs to take steps to insure her safety.

I suggest that the counselor first talk with the girl about the necessity of disclosure, for her own benefit as well as that of her parents, the boy involved and the unborn child. Ideally, her parents, or both hers and the boy's parents could come to the school immediately to begin the conversation, with the counselor present. Chances to preserve the student-counselor relationship are greatly enhanced if the counselor can be part of the initial discussion. However, many parents prefer to talk privately with their child before allowing a counselor to be present, a preference important to respect. My preference is to include the boy and his parents in discussions, too, perhaps at a later time, but early in the process, because both students need to face the consequences of their actions, with help and guidance from both sets of parents. This is not a crisis that such young people are able to face alone. Nor is it one that the counselor should take on as his or her sole responsibility.

I recognize the potential for the student-counselor relationship to suffer in such a crisis. I remember a time that I reported the parents of one of my counselees for suspected physical abuse. A Department of Family Services investigation began the next day with a visit to the home to confront the parents about the allegation. They were outraged and immediately assumed that I had made the report (even though this information is kept confidential). The next morning they met with the school principal and withdrew their permission for me to continue counseling their daughter. To their credit, they accepted an appointment with me, during which I answered their questions honestly. But their decision was final. Thus, the daughter lost me as a confidante.

Nevertheless, many positive things happened during the next several months. The girl lost weight (that she needed to lose); both parents attended school functions (something they had rarely done before); and the girl became more outgoing and expressive with peers, in contrast to her usual shy demeanor. In retrospect, I think the gains made by this family following the anger and embarrassment associated with the report were significant and might not have occurred without it.

On the whole, I have a great deal of confidence in parents and respect for their lifelong relationship with each of their children. As a school psychologist, I see myself as a support to that relationship, even when that support takes the form of "bad news." Making mistakes is human. We all make poor judgments from time to time. Blame and shame don't resolve bad decisions. As a parent myself, I want to know about my child's troubles as well as successes, and I appreciate thoughtful and respectful efforts to help my child and me recognize and resolve those troubles.

Every situation, like every person, is different, thus deserving of a singular response appropriate to the circumstances and people involved. School counselors, psychologists, social workers and other support personnel can, should and often do consult with each other, as well as with the school principal or other supervisory personnel to talk over problems that arise with individual students in order to make judicious decisions on their behalf. Applicable laws and regulations shed additional light on each case to help guide choices for constructive and appropriate action.

Links:

Duty to Report

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Please send questions or comments to bbruno@snet.net.